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Book Summary: In Stitches by Dr Nick Edwards

In Stitches is written by a doctor who has worked in many hospitals and is training to become a Consultant. I really enjoyed this book as I learned a lot about the NHS and the reality of being a doctor. Dr Edwards covers a lot of material including NHS reforms, management, funding, certain illnesses, current problems in our population, the future of medicine and feelings about being a doctor, through case studies – ensuring that the information is always interesting to read and not just lists of NHS regulations!

Dr Edwards feels that managers are not directly at fault for the problems in our NHS, but that it is ‘unintended consequences’ of new policies brought about by the government which are to blame. He believes that some new policies have lead to failures, damaging patient care and the NHS’ reputation. He talks about a brief history of the NHS including that its creation was overseen by Nye Bevan in 1948 and that underfunding appeared to start in 1997. I was interested to find out that 1997 was therefore the year that the ‘4-hour rule’ was introduced – a rule which states that 98% of patients must be seen and admitted or discharged within four hours’. Dr Evans feels that this rule is now outdated. Measures are often taken in order to ensure hospitals do not breach this rule for example by moving curtains to fake admittances, adjust figures and cancelling operations in order to increase bed space. He also expresses in In Stitches that he feels that he is ‘no longer allowed to do good-willed gestures’ as he must constantly ensure he is not breaching NHS rules. This is a shame as it means that doctors are not able to fulfil their role (‘not allowed to do the job properly’) and use the ‘gold standard skills’ that they spend a long time learning at medical school, for fear of breaching regulations. Dr Edwards talks about this leading to patients no longer receiving the level of care that they require and deserve.

Medical conditions that I read about in this book are addiction, Type 2 Diabetes, psychosis and schizophrenia, atrial fibrillation and appendicitis. Most of these conditions were linked with Cannabis, Alcohol, Cocaine and Heroin.

Being a doctor can be extremely difficult. Dr Edwards expresses that you must be ‘mentally strong’ and able to ‘cope with stress’ to be a doctor and must be able to detach yourself from patients in order to provide the best quality of care. Detaching yourself from your patients is extremely important to ‘protect’ yourself from mental health problems. In addition, I learned that it is okay to have a limit in your ability and important to understand that sometimes it is best to let ‘nature take its course’ when you have ‘treated the patient to the best of your ability’. Dr Edwards also talked about enjoyment of working with lots of different people from all cultures, and getting the ‘buzz’ from working in a high-pressure environment.

Problems of the NHS that he talks about in In Stitches are wasted funding, long hours and the postcode lottery. Dr Edwards noticed that many members of staff were often not needed at certain times including when there are hardly any cars in the car park but there are often two car parking attendants sitting around who are employed by the NHS, and when operations are cancelled due to shortage of beds but surgeons remain in work, waiting around needlessly. Furthermore, he stresses the importance for need to cut down number of hours in Junior Doctors’ shifts. Long hours leads to severe tiredness and this directly affects patients’ care negatively. Dr Edwards asked himself the question ‘Would I have treated her the same way if I had not been exhausted?’ showing that his mood was affecting his ability to work. The postcode lottery is something often discussed as a problem surrounding the NHS as it could be said that some people have better access to medical facilities than others, depending on where they live. Dr Edwards suggests that this may not actually be the case and that it is just the local area’s advertisement or lack of advertisement of the other medical facilities on offer (as opposed to just A&E) that affects the number of people using them and therefore affects the number of people coming to A&E.

Solutions offered to some problems include improving saving of patient test results as money is wasted repeating tests and preventing unnecessary admission to wards in order to reach targets. The money that these activities cost could be put to better use elsewhere for example for more personalised care for the elderly by home visits, investment into specialist units and improvement of quality of care homes.

To conclude the book, Dr Edwards assures the reader that ‘the good bits outweigh the bad bits’ but clearly believes that it is important to understand both the positives and negatives of being a doctor before applying to medical school. He then goes on to suggest that it is most important to look after yourself under the pressurising conditions of working in a hospital, in order to be the most benefit to your colleagues and your patients. The book also raised the question whether it is ethically correct to treat someone, even when it is against their wishes.